Laserfiche WebLink
PERMITTEE NAME/ADDRESS (include Pacifity A'arne/%carion if Differenu <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR M DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMErrITLE PRINCIPAL EXECUTIVE OFFICER I certif.% under primps of lam that Ihiv document and all attachments mere <br />d <br />h <br />d <br />i <br />d TELEPHONE DATE <br /> u systrm <br />prepared under m direction or supervision in as or <br />anve wit <br />es <br />gne <br /> to msure that qualified personnel properly gather and evalualr the information <br /> submiurd. Rased on my inquiry or the w-n or perams who manage the svvtem. <br /> or thou penonv diredh respemsiMr for gathering thr information, the information <br /> submiurd k, to the tall of my knouledgr and belief, true. accurate. and nnnploe. <br />i <br />f <br />f <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED on, <br />1 am uware that there are significant penalties for uhm <br />ttinX <br />alvr in <br />ormat <br />including the pensibilih or fume and imprisonment for knowing violations. <br />OFFICER OR AUTHORIZED AGENT AREA <br />COD NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. -vW) Previous editions may be used. This is a 4-part form.